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SEP 0 3 2015 <br />Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or print <br />current contact information: <br />Permittee Contact: <br />Howard McGinnis <br />Permittee Company: <br />Yuma County <br />Address: <br />1310 S. Blake St. <br />Wray, CO 80758 <br />Phone Number: <br />(970) 332-5718 <br />Fax Number: <br />(970) 332-3429 <br />Email Address: <br />Howardycrb@centurytel.net <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />being conducted in accordance with the Division approved mining and reclamation plans. <br />Signature of Permittee. Coruorate Officer, Owner, or Documented Designee <br />M -AF -04 <br />Date <br />